Author Topic: Going to have double jaw surgery  (Read 4482 times)

GJ

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Re: Going to have double jaw surgery
« Reply #15 on: November 11, 2019, 07:47:15 PM »
Agree CW case (or linear).
Probably could get away with linear and lower only if you extract two lower premolars. Alternative plan would would be clockwise rotation of both jaws, adjusting chin as needed. The latter comes with the risk of more nerve damage/nose issues, but it might be better. Hard to say. Get more records, etc.
Millimeters are miles on the face.

mick9876

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Re: Going to have double jaw surgery
« Reply #16 on: November 11, 2019, 08:46:08 PM »

I think CW is more on target with your case than is CCW. To this regard, I will show you a case from a 'Grand Wazoo' of CCW (Gunson) who has actually done a CW rotation on a patient who is pretty much similar to you.  But, of course, he avoids telling people straight out it's a CW case and not a CCW case.

Here's a Gunson case, pretty similar to yours (although no case is 'exactly' like anothers'). The red lines I drew on the model to illustrate what I meant by an overall down graft in direction of CLOCKWISE rotation for the short face. Observe it is longer in front than in back.   Gunson, doesn't seem to tell people straight out when he's doing CW. He certainly didn't announce it on the FB page I found this example. But this is an example of CW with the the type of overall downgraft I was suggesting in my posts.


As I said prior, the CW will give you the elongation to the face needed and a genio can also be added.  The Gunson case has the CW via overall downgraft to the maxilla, advancement of both maxilla and mandible and also a genio.

photo or diagram included in this post.


Yeah, this looks like a really good result

mick9876

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Re: Going to have double jaw surgery
« Reply #17 on: November 11, 2019, 11:13:04 PM »
Btw, here is a morph that one of the surgeons did. Looks pretty strange because of that "cheek augmentation" and nose but other than that the movements of the jaws look okay to me, if the results were something like that i would definitely want genio.
« Last Edit: February 10, 2020, 05:23:04 AM by mick9876 »

InvisalignOnly

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Re: Going to have double jaw surgery
« Reply #18 on: November 12, 2019, 12:15:05 AM »
Looks pretty strange because of that "cheek augmentation" and nose

Yeah, if it was up to Dr D, nearly 100% of people would walk around with those PEEK implants in the cheek and a nose job lol. Funny how a lot of surgeons have one or two favourite procedures (chin wing or whatever) and they're (hopefully, genuinely) convinced everyone would just look sooo much better if they got that one thing done.

Post bimax

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Re: Going to have double jaw surgery
« Reply #19 on: November 12, 2019, 07:00:26 AM »
Yeah, if it was up to Dr D, nearly 100% of people would walk around with those PEEK implants in the cheek and a nose job lol. Funny how a lot of surgeons have one or two favourite procedures (chin wing or whatever) and they're (hopefully, genuinely) convinced everyone would just look sooo much better if they got that one thing done.

To be fair the nose looks pretty good

mick9876

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Re: Going to have double jaw surgery
« Reply #20 on: November 12, 2019, 07:25:14 AM »

To be fair the nose looks pretty good

Just out of curiosity, i wonder how others see me in the morphed version, since i think i look really really weird and not in a good way but when i crop those photos to show only the lower third, i think the morphed version is 10x better and looks good for a double jaw result.

So i thought to myself that it is the cheek augmentation thing that is making me look weird but is it just me and might it be because it is a photo of me and i look so different?

And yeah, i really hope moving the upper jaw will rotate my nose like that, i mean right now it looks pressed down/down turned and when i smile or laugh it highlights and i look like a troll.

InvisalignOnly

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Re: Going to have double jaw surgery
« Reply #21 on: November 12, 2019, 08:06:12 AM »
So i thought to myself that it is the cheek augmentation thing that is making me look weird

Yeah, I think it is. I suspect the same person did exactly the same thing to me (cheek stuff) and it looked weird on me too. (I mean in the morph, not in real life, as I didn't actually get it.) I agree that the projected result of the jaw surgery itself looks good on you. One of the problems with morphing is that while it's quite easy to do from profile, it's very difficult to do from the front and at the end of the day, it's the front view that counts because you'll spend the rest of your life looking at yourself from the front in mirrors etc. I'm not saying it would not look good from the front if you got the surgery, just pointing it out that it's difficult to visualize.

kavan

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Re: Going to have double jaw surgery
« Reply #22 on: November 12, 2019, 09:51:52 AM »
Just out of curiosity, i wonder how others see me in the morphed version, since i think i look really really weird and not in a good way but when i crop those photos to show only the lower third, i think the morphed version is 10x better and looks good for a double jaw result.

So i thought to myself that it is the cheek augmentation thing that is making me look weird but is it just me and might it be because it is a photo of me and i look so different?

And yeah, i really hope moving the upper jaw will rotate my nose like that, i mean right now it looks pressed down/down turned and when i smile or laugh it highlights and i look like a troll.

I see the morph as a suggested 'add-on' or 'toss-in' in the absence of it being made CLEAR to you why it's been thrown in to you your morph.

You have very good aesthetic self perception and observational ability.

The lower '1/3rd', area from base of nose to base of chin, is certainly improved in the morph. That area would get advanced in bimax.

Now the area above base of nose, and the paranasal area (lower medial cheek area next to sides of nose) would also get advanced as to yield a better slope to the whole nose.

Downward rotated nose tip/base (which you have) is common thing to see with maxilla recession.
When base of nose is advanced in cases like that, there is 'de-rotation' to it which is in reverse direction of what ever rotation it has. An overly downward rotated nose (often consistent with maxilla retrusion) can get a better slope to nose profile from the advancement. Sunken cheek areas beside lower 1/2 of nose can get better curvature.
 
Another way to say this, is that you effectively get a 'FREE' rhino and even though the base of nose is advanced with the Lefort 1, together with the area beside nose, that also gets advanced, the nose will look not only straighter on the face, but also LESS prominent.

Now, I know that and they know that as to BONUS rhino effect. But there would be some doctors who might want you to attribute changes that could arise from the bimax alone to EXTRA-ADD ONS; act of 'upselling' ancillary procedures.

No idea IF the guy is conveying in morph; 'Here's what you'd look like with an (extra charge) rhino and cheek augment. But IF that's the case, I can tell you that the positive nose effect and the fuller sagittal cheek curve--the PART of it beside the LOWER 1/2 of nose-- is pretty much consistent with Lefort 1 advancement when someone has retrusive maxilla along with prominent and downward rotated nose as you have.

Sagittal cheek curve is convex curve running from below eye to beside base of nose area. On the morph, the WHOLE curve is filled out which includes the part of it besides the UPPER 1/2 of it beside upper 1/2 of nose. THAT part of it would not get advanced out with the Lefort 1.

Basically, the doctor morphed the ORBITAL RIM area below the eye which is area that contributes to 'sagittal' CURVE. He even morphed it TOO HIGH because the bone is found BELOW the lash line and he started the curve right under the lash line.

So, as to the whole SAGITTAL CURVE he enhanced where only the upper 1/2 of that curve would apply to extra augmentation, it would depend how he communicated to you. Like if he said something like; 'Your ORBITAL RIM area below your eyes will look more recessive to you.', well ya, it could look more recessive to you after L1 advancement.  But when they use the word: 'CHEEK' area, common usage refers to an area more LATERAL to where he augmented the midface sagittal curve.

I would try to narrow down WHAT he was wanting to convey to you in the morph, and let's hope it was NOT an extra rhino because as I said, the type of surgery you would be getting would have with it a 'free rhino effect'. The area in the morph that clearly would not be part of L1 advance was to ORBITAL RIM area. That's the area seen via the SAGITTAL (midface) curve on PROFILE view. The other curve; 'ogee' is one where common usage calls it 'CHEEK' curve and that curve is seen in 3/4 view.  So, establish WHICH part of bone structure to upper midface he's wanting to augment. Because when they augment the area commonly called 'cheek', it can be an area LATERAL to where the augmentation is needed and can even exaggerate the area that really needs the augmentation (orbital rim).

As to any 'extras' or 'add-ons', 'toss-ins' a doctor suggests along with the SALIENT surgery, they actually should be CLEARER about those things than the bimax surgery itself. WHY? Because the add ons are (I'm assuming) something you did NOT specifically ask for where the maxfax/bimax itself was. So, it will depend on how clear he was explaining to you YOUR 'need' for any of his suggested add ons.



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kavan

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Re: Going to have double jaw surgery
« Reply #23 on: November 12, 2019, 10:16:35 AM »
Yeah, I think it is. I suspect the same person did exactly the same thing to me (cheek stuff) and it looked weird on me too. (I mean in the morph, not in real life, as I didn't actually get it.) I agree that the projected result of the jaw surgery itself looks good on you. One of the problems with morphing is that while it's quite easy to do from profile, it's very difficult to do from the front and at the end of the day, it's the front view that counts because you'll spend the rest of your life looking at yourself from the front in mirrors etc. I'm not saying it would not look good from the front if you got the surgery, just pointing it out that it's difficult to visualize.

An automatic morph program would not be able to show changes to front as easily as those to side view. It would need extra programming in 'artificial intelligence' to relate profile changes back to the frontal view. However, an artist could easily show such things as how projected out curves look from the front. Think portrait painting. Like not a thing where they say; 'I can only paint your profile.' Artists know how to use light and shadow where auto morph programs don't. I've had people ask me; 'What PROGRAM did you use to show projection in front?'Answer: 'No auto morph program. Just knowledge in art concepts.'
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mick9876

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Re: Going to have double jaw surgery
« Reply #24 on: November 12, 2019, 10:47:48 AM »
-

« Last Edit: October 14, 2020, 04:25:50 PM by mick9876 »

kavan

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Re: Going to have double jaw surgery
« Reply #25 on: November 12, 2019, 11:21:12 AM »
Thank you once again for taking the time and effort to reply!

We did not talk anything about extras like the cheek augmentation in the consultation, he just dedicated to include them in the morph, might be mentioning them when we go further in to treatment.

But yeah, i am going for the djs, will be interesting to see how my cheeks will look after that tho.

With this surgeon communication was a bit off, otherwise he seemed proficient but i guess i cant expect more since it was a fast skype consultation.

Also this surgeon seems to think that sarpe is mandatory for me. Other surgeons have not mentioned sarpe at all expect one whom i asked about it and he said that i do not seem to need it at this point at least. Anyways, i will be asking about this in the upcoming meetups with whomever surgeon i will be seeing.

Hard for me to opine on the SARPE because that expands distance from teeth on one side of maxilla to the other side. SARPE can fill in the smile by filling in what they call the 'buccal corridors' which are shadowed areas to the smile where you don't see the back teeth in the smile. Thing is that when the maxilla (with it's teeth) is brought forward, the back teeth that you don't see in the smile, when it's backward, are brought more into the FOREground and then you see them more in the smile. Segmental lefort can also help with filling out transverse smile deficiencies.  Hence, I can't really call it, from here or opine much on the need for the SARPE other to tell you that if it's suggested to fill in buccal corridors, the act of bringing the maxilla forward and also possibly doing segmental lefort would also assist with that objective IF that were the objective.

My 'antennae' are picking up that there is a doctor in the mix wanting to do extra add ons and might be of type of; 'I'm the doctor and I said so.'  I'm picking up that this might be an older doctor.  Are the 'vibes' I'm getting correct?
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mick9876

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Re: Going to have double jaw surgery
« Reply #26 on: November 12, 2019, 11:42:17 AM »
Hard for me to opine on the SARPE because that expands distance from teeth on one side of maxilla to the other side. SARPE can fill in the smile by filling in what they call the 'buccal corridors' which are shadowed areas to the smile where you don't see the back teeth in the smile. Thing is that when the maxilla (with it's teeth) is brought forward, the back teeth that you don't see in the smile, when it's backward, are brought more into the FOREground and then you see them more in the smile. Segmental lefort can also help with filling out transverse smile deficiencies.  Hence, I can't really call it, from here or opine much on the need for the SARPE other to tell you that if it's suggested to fill in buccal corridors, the act of bringing the maxilla forward and also possibly doing segmental lefort would also assist with that objective IF that were the objective.

My 'antennae' are picking up that there is a doctor in the mix wanting to do extra add ons and might be of type of; 'I'm the doctor and I said so.'  I'm picking up that this might be an older doctor.  Are the 'vibes' I'm getting correct?

Yes he is an older doctor, has been talked about a lot in the surgeon reviews and leads but have not found that many who has done surgery with him, a lot of consultations tho.

In his proposal he said that we could skip sarpe for now but then i sent him some extra questions over email and then he i guess looked at my pictures again and told that he thinks sarpe is mandatory, i never got a proposal for sarpe tho so i might be mistaken too.

I think i should just email him and ask

about the extra add on vibes, i cant really tell since he did not yet suggest anything else than sarpe and bimax and might be that i really need sarpe, will have to look in to this.

kavan

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Re: Going to have double jaw surgery
« Reply #27 on: November 12, 2019, 12:35:30 PM »
Yes he is an older doctor, has been talked about a lot in the surgeon reviews and leads but have not found that many who has done surgery with him, a lot of consultations tho.

In his proposal he said that we could skip sarpe for now but then i sent him some extra questions over email and then he i guess looked at my pictures again and told that he thinks sarpe is mandatory, i never got a proposal for sarpe tho so i might be mistaken too.

I think i should just email him and ask

about the extra add on vibes, i cant really tell since he did not yet suggest anything else than sarpe and bimax and might be that i really need sarpe, will have to look in to this.

Well, as I conveyed...I can't fine point 'call it' as to need or not for SARPE. Just to say IF it's suggested for buccal corridor filling what the other things were to do similar.  In general, the more you can target your own short comings ('your' is used in the collective sense and can apply to everyone/anyone), the more you can 'ID' with a doctor's aesthetic suggestions.
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kavan

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Re: Going to have double jaw surgery
« Reply #28 on: November 12, 2019, 12:48:37 PM »
To mick9876,


I think the KEY thing to look for, in your case, is the over-all DOWNGRAFT (CW) that I mentioned. That alone would tend to narrow down your selection and knock some doctors out of the mix.
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InvisalignOnly

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Re: Going to have double jaw surgery
« Reply #29 on: November 12, 2019, 11:56:56 PM »
An automatic morph program would not be able to show changes to front as easily as those to side view. It would need extra programming in 'artificial intelligence' to relate profile changes back to the frontal view. However, an artist could easily show such things as how projected out curves look from the front. Think portrait painting.

Interesting you say that, I have just started searching for someone that would sketch my portrait showing projected results of different kinds of jaw surgeries. I am not a visual type at all, always find it very hard to visualize anything. One of the surgeons I contacted offered to show me possible outcomes based on CBCT and other data, and he said it would cost me EUR 1,500! I think there must be a cheaper way to do this. I feel I cannot make a decision about major surgery like this while I simply have no idea what I'd possibly look like as a result.